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General NPI Number Information
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NPI Number | 1538220215
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Entity Type | Organization
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Legal Business Name | KONZA ORAL AND MAXILLOFACIAL SURGERY PA
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Dates
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Enumeration Date | 12/13/2006
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Last Update Date | 09/14/2012
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Provider Practice Location Address
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Address Line | 1133 COLLEGE AVE BUILDING C SUITE 200
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City | MANHATTAN
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State | KS
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Zip | 66502-2770
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Country | US
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Telephone | 785-539-7429
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Fax |
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Provider Business Mailing Address
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Address Line | 1133 COLLEGE AVE STE 200 BLG C
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City | MANHATTAN
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State | KS
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Zip | 66502-2756
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Country | US
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Telephone | 785-539-7429
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MS. RONNA JEAN YOUNG
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Credential |
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Telephone | 785-539-7429
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number |
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License Number State |
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